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LIVER DISEASE


Inducing immune responses to HBV


Over the past few years, the way that HBV can evade the pattern recognition capabilities of the innate immune system has been explored. Promoting a more complete immune response to the virus is another potential avenue to fighting persistent infection. This strategy was investigated in a Phase 2, randomised, double-blind, placebo-controlled study that explored the efficacy and safety of 24 weeks of treatment with the Toll-like receptor 8 (TLR8) agonist selgantolimod. Thirty-nine virally suppressed adults


with chronic HBV infection received oral selgantolimod (1.5 mg or 3.0 mg) or placebo once weekly for 24 weeks. Dose- proportional increases in cytokines and changes in natural killer (NK), dendritic cells (DC) and CD8+ T cells were observed. The treatment was well- tolerated and, at Week 48, 5% had a loss of HBsAg, and 16% HBeAg-positive patients had achieved HBeAg loss. These latest breakthroughs offer patients hope for the future – the development of novel therapeutics for persistent HBV infection is currently one of the most vibrant fields in hepatology. “With so many different approaches that show promising results in HBsAg- decline, and even HBsAg-loss, we appear to be edging closer to the development of a functional cure,” concluded Dr Tobias Böttler from the University of Freiburg, Germany.


Calls to tackle late diagnosis of liver disease Liver disease is on the rise. Since 1970, deaths due to liver disease have increased by 400%. This is in stark contrast to other major diseases, such as heart disease and cancer, in which the number of deaths have either remained stable or decreased. In the UK, liver disease is the third leading cause of premature death and yet 90% of liver disease is preventable. In addition, three-quarters of people are currently diagnosed at a late stage when it is too late for lifestyle changes or intervention A new campaign has been launched to stop thousands of people with liver disease dying unnecessarily. One in four patients diagnosed in hospital with severe liver disease in England and Wales die within 60 days because of late diagnosis. The British Liver Trust is calling for much better awareness and proper treatment pathways to be put in place in primary care across the UK, and has launched a petition demanding these changes. The new campaign, Sound the Alarm on Liver Disease, is urging the government to transform care for those


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With the shortage of liver grafts and the increasing prevalence of cirrhosis, better prediction of mortality and improved prioritisation for liver transplantation are becoming increasingly important.


with liver disease, and improve early diagnosis to save lives. The campaign is supported by leading UK hepatologists and clinicians, and is endorsed by the British Association for the Study of Liver Disease and British Society of Gastroenterologists. Professor Steven Ryder, medical advisor to the British Liver Trust, commented: “Currently three-quarters of people with liver disease are diagnosed very late in a hospital setting. At this stage, their condition is generally so advanced that there are few treatment options, and transplantation is their only hope. Around a quarter of those patients die within 60 days. This has to stop. “The tragedy is that, in most cases, these deaths could have been avoided with earlier diagnosis. The liver is a remarkable organ and can often repair or reverse damage if steps to do this are taken in time. We know that the changes that we are asking for are possible as there are pockets of excellent care for liver patients in some parts of the UK, but provision is patchy and many areas do not have anything at all in place to ensure that people with liver disease are picked up early. Care for liver patients should not be a postcode lottery. We need to sound the alarm and demand earlier diagnosis for all liver patients throughout the UK today.”


Sound the Alarm on Liver Disease is calling for three key changes to transform early diagnosis so that people with liver disease can be diagnosed at a much earlier stage and lives can be changed. By signing the petition, signatories will be calling for:


n every GP practice to have an agreed way of finding patients at risk, testing, following up and managing, and referring to secondary care when necessary


n the NHS (over 40s) Health Check in England and other regular checks across the devolved nations to be routinely used to find those at risk of liver disease


n automated processes to be put in place in primary care to identify those at risk of liver disease, to include the correct blood tests and to manage appropriate follow-up.


Pamela Healy OBE, British Liver Trust chief executive, commented: “We know GPs have lots of different conditions to consider – however, by automating processes, we know that those at risk of liver disease can be easily flagged up and targeted for intervention. Since 1970, deaths due to liver disease have increased by 400%, and one in five of us are currently at risk of developing a liver condition. The clock is ticking – we can’t afford to wait any longer. We must take action today to save lives in the future.” PPi


The International Liver Congress 2021 is scheduled to take place on 22–25 June, in Amsterdam, The Netherlands. Details of the conference programme can be accessed online (https://easl.eu/event/ the-international-liver-congress-2021-2).


This article first appeared in The Clinical Services Journal (Advancing hepatology: research findings. CSJ 2020 November; 19 [10]: 47–51), and is reproduced here in edited form by kind permission.


DECEMBER 2020 WWW.PATHOLOGYINPRACTICE.COM


PATHOLOGY IN PRACTICE


haitham alfalah ...commons.wikimedia.org CC BY-SA 4.0


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